Tuesday 14 August 2012

TENNIS ELBOW -- AN OVERVIEW

"Tennis elbow" is a common term for a condition caused by overuse of arm, forearm, and hand muscles that results in elbow pain. You don't have to play tennis to get this, but the term came into use because it ca
n be a significant problem for some tennis players.

Tennis elbow is caused by either abrupt or subtle injury of the muscle and tendon area around the outside of the elbow. Tennis elbow specifically involves the area where the muscles and tendons of the forearm attach to the outside bony area (called the lateral epicondyle) of the elbow. Your doctor may call this condition lateral epicondylitis. Another common term, "golfer's elbow," refers to the same process occurring on the inside of the elbow -- what your doctor may call medial epicondylitis. Overuse injury can also affect the back or posterior part of the elbow as well.

Tennis elbow most commonly affects people in their dominant arm (that is, a right-handed person would experience pain in the right arm), but it can also occur in the nondominant arm or both arms.

What Are the Symptoms of Tennis Elbow?

Symptoms of tennis elbow include:

Pain slowly increasing around the outside of the elbow. Less often, pain may develop suddenly.
Pain is worse when shaking hands or squeezing objects.
Pain is made worse by stabilizing or moving the wrist with force. Examples include lifting, using tools, opening jars, or even handling simple utensils such as a toothbrush or knife and fork.
Who Gets Tennis Elbow?

Tennis elbow affects 1% to 3% of the population overall and as many as 50% of tennis players during their careers. Less than 5% of all tennis elbow diagnoses are related to actually playing tennis.

Tennis elbow affects men more than women. It most often affects people between the ages of 30 and 50, although people of any age can be affected.

Although tennis elbow commonly affects tennis players, it also affects other athletes and people who participate in leisure or work activities that require repetitive arm, elbow, wrist, and hand movement, especially while tightly gripping something. Examples include golfers, baseball players, bowlers, gardeners or landscapers, house or office cleaners (because of vacuuming, sweeping, and scrubbing), carpenters, mechanics, and assembly-line workers.

How Is Tennis Elbow Diagnosed?

Tennis elbow cannot be diagnosed from blood tests and rarely by X-rays. Rather, it is usually diagnosed by the description of pain you provide to your doctor and certain findings from a physical exam.

Since many other conditions can cause pain around the elbow, it is important that you see your doctor so the proper diagnosis can be made. Then your doctor can prescribe the appropriate treatment.

Tennis elbow usually is successfully treated by medical means -- such as physical therapy, forearm bracing to rest the tendons, topical anti-inflammatory gels, topical cortisone gels, and cortisone injections. It only rarely requires surgery.

The type of treatment prescribed for tennis elbow will depend on several factors, including age, type of other drugs being taken, overall health, medical history, and severity of pain. The goals of treatment are to reduce pain or inflammation, promote healing, and decrease stress and abuse on the injured elbow.

How Is Pain and Inflammation Reduced in Tennis Elbow?

To reduce the pain and inflammation of tennis elbow, try:

Rest and avoid any activity that causes pain to the sore elbow.
Apply ice to the affected area.
Take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
Cortisone-type medication may be put on topically by you or injected into the sore area by your doctor.

How Can I Promote Healing of My Tennis Elbow?

This step begins a couple of weeks after the pain of tennis elbow has been reduced or eliminated. It involves specific physical-therapy exercises to stretch and strengthen muscles and tendons around the injured elbow. Any activity that aggravates the pain must be avoided.

How Do I Decrease Stress and Abuse on Tennis Elbow?

To help lessen the continued stress and abuse on tennis elbow:

Use the proper equipment and technique in sports and on the job.
Use of a counter-force brace, an elastic band that wraps around the forearm just below the injured elbow (tendon) may help to relieve pain in some people.
Avoid tight gripping, overuse of the wrist.
Pay attention to the movements that cause pain.


What Is the Outlook for People With Tennis Elbow?

Overall, 90% to 95% of people with tennis elbow will improve and recover with the treatment plan described. However, about 5% of people will not get better with conservative treatment and will need surgery to repair the injured muscle-tendon unit around the elbow. For 80% to 90% of people who have surgery, it results in pain relief and return of strength.

Rehab For Tennis Elbow:
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The Super 7

The "super 7” exercises are an important part of treatment for tennis elbow. They are designed to strengthen the muscles in the forearm and increase flexibility through stretching. In most cases te these exercises will help relieve elbow pain in about 4 to 6 week Each stretching exercise is held for 15 seconds and repeated 2 or 3 times. This pattern is repeated 5 times a day.

Exercise 1. Stretching the muscles that extend the wrist (extensor muscles): Straighten the arm out fully and push the palm of the hand down so you feel a stretch across the top of the forearm.

Exercise 2. Stretching the muscles that flex the wrist (flexor muscles): straighten the arm out fully (palm side up), and push the palm downward to stretch. Strengthening exercises are performed twice a day following the stretching exercises. To perform these exercises, the patient sits in a chair with the elbow supported on the edge of a table or on the arm of the chair the wrist hanging over the edge. Use a light weight such as a hammer or soup can when performing the strengthening exercises. Repeat the exercises 30 to 50 times, twice a day, but do not push yourself beyond the point of pain.

Exercise 3. Strengthening wrist extensor muscles: Hold the weight in the hand with the palm facing down. Extend the wrist upward so that it is pulled back. Hold this position for 2 seconds and then lower slowly.
Exercise 4. Strengthening wrist flexor muscles: Hold the weight in the hand with the palm up. Pull the wrist up, hold for 2 seconds and lower slowly.

Exercise 5. Strengthening the muscles that move the wrist from side to side (deviator muscles): Hold the weight in the hand with the thumb pointing up. Move the wrist up and down, much like hammering a nail. All motion should occur at the wrist.

Exercise 6. Strengthening the muscles that twist the wrist (pronator and supinator muscles): Hold the weight in the hand with the thumb pointing up. Turn the wrist inward as far as possible and then outward as far as possible. Hold for 2 seconds and repeat as much as pain allows, up to 50 repetitions.

Exercise 7. Massage is performed over the area of soreness. Apply firm pressure using 2 fingers on the area of pain and rub for 5 minutes.

If exercise aggravates any of your symptoms, contact a physician or physical therapist These exercises can be used to prevent or rehabilitate injuries in people who play sports or in those who do repetitive forearm work.

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